Fetal heart rate variability and complexity in the course of pregnancy

Leeuwen, P. van; Lange, Silke; Bettermann, Henrik; Grönemeyer, Dietrich; Hatzmann, Wolfgang

doi:10.1016/s0378-3782(98)00102-9

Cited by 139 publications

(104 citation statements)

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“…On the other hand, clinically established criteria of fetal maturation, such as the increasing number and extent of movement-related heart rate accelerations and the formation of active and quiet states with increasing duration and differentiation (33), are consistent with general developmental characteristics and indicate the potential of a correspondingly focused HRV analysis. From single-scale HRV measures contradictory results are reported, such as increasing complexity during fetal growth and maturation as well as decreasing complexity in connection with the formation of heart rate accelerations patterns (14,49,52).Traditional HRV analysis is based on natural rhythms such as the heartbeat period itself, the high-frequency band assigned to vagal heart rate modulations, the low-frequency band assigned to vagal and sympathetic heart rate modulations, and the very-low-frequency band (VLF) integrating several autonomic and humoral control loops. The limitation of this simplification already becomes obvious when one takes into account that sympathovagal interactions operate both in an antagonistic and…”

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“…Moreover, it is self-evident that the isolated activity of one particular autonomic branch cannot explain the complex integrative control mediated by the ANS. Hence, it is not surprising that integrative indices of conventional linear analysis [standard deviation of NN intervals (SDNN), VLF, see Table 1] and potentially more adequate complexity indices provided relevant diagnostic and prognostic values in several clinical studies of adult patients (e.g., 13,18,25,36,43) as well as with regard to the normal fetal maturation (e.g, 16,48,52).…”

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Fetal development of complex autonomic control evaluated from multiscale heart rate patterns

Hoyer

Nowack

Bauer

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

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U. Fetal development of complex autonomic control evaluated from multiscale heart rate patterns. Am J Physiol Regul Integr Comp Physiol 304: R383-R392, 2013. First published December 26, 2012 doi:10.1152/ajpregu.00120.2012.-Development of the fetal autonomic nervous system's integrative capacity in relation to gestational age and emerging behavioral pattern is reflected in fetal heart rate patterns. Conventional indices of vagal and sympathetic rhythms cannot sufficiently reflect their complex interrelationship. Universal behavioral indices of developing complex systems may provide additional information regarding the maturating complex autonomic control. We investigated fetal magnetocardiographic recordings undertaken at 10-min intervals in active (n ϭ 248) and quiet (n ϭ 111) states between 22 and 39 wk gestational age. Standard deviation of heartbeat intervals, skewness, contribution of particular rhythms to the total power, and multiscale entropy were analyzed. The multiscale entropy methodology was validated for 10-min data sets. Age dependence was analyzed by linear regression. In the quiet state, contribution of sympathovagal rhythms and their complexity over a range of corresponding short scales increased with rising age, and skewness shifted from negative to positive values. In the active state, age dependencies were weaker. Skewness as the strongest parameter shifted in the same direction. Fluctuation amplitude and the complexity of scales associated with sympathovagal rhythms increased. We conclude that in the quiet state, stable complex organized rhythms develop. In the active state, however, increasing behavioral variability due to multiple internal coordinations, such as movement-related heart rate accelerations, and external influences develop. Hence, the state-selective assessment in association with developmental indices used herein may substantially improve evaluation of maturation age and early detection and interpretation of developmental problems in prenatal diagnosis. autonomic nervous system; complexity; developmental biology; fetal maturation; fetal behavioral patterns THERE IS INCREASING CONSENSUS that a certain number of diseases such as cardiovascular disease, metabolic syndrome, atherosclerosis, Type 2 diabetes, learning difficulties, hyperkinetic disorders, as well as cognitive, behavioral, and emotional problems in late postnatal age are associated with adverse influences during fetal development that became permanently programmed (1,2,4,10,11,19,20,23,24,26,31,32,39,40,44,47). However, early identification of fetal developmental problems is a challenging topic of prenatal diagnosis due to the extremely limited number of observable variables from the fetus. During the fetal maturation the emerging complex behavioral patterns are associated with an increasing functional integration in the organism. In that connection the autonomic nervous system (ANS) plays a predominant role for complex coordinated control of multiple vitally important physiological subsystems in the organism. Sin...

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Fetal development of complex autonomic control evaluated from multiscale heart rate patterns

Hoyer

Nowack

Bauer

et al. 2013

American Journal of Physiology-Regulatory, Integrative and Comp

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“…It is known from previous studies that the heart rate of the human fetus decreases from month to month with the advancement of pregnancy (Wheeler et al, 1979;van Leeuwen et al, 1999). Nagel et al (2010Nagel et al ( , 2011 have found that the same occurs in the equine fetus, with an increase of HRV during gestation.…”

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confidence: 83%

“…In humans, the variability of fetal heart rate increases markedly in the third trimester of pregnancy. This can probably be attributed to the maturation of the vegetative nervous system which influences cardiac function (Wheeler et al, 1979;van Leeuwen et al, 1999).…”

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Fetal heart rate and fetal heart rate variability in Lipizzaner broodmares

Vincze¹,

Baska

Szenci

2015

Acta Veterinaria Hungarica

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Monitoring fetal heart rate (FHR) and fetal heart rate variability (FHRV) helps to understand and evaluate normal and pathological conditions in the foal. The aim of this study was to establish normal heart rate reference values for the ongoing equine pregnancy and to perform a heart rate variability (HRV) timedomain analysis in Lipizzaner mares. Seventeen middle-and late-term (days 121-333) pregnant Lipizzaner mares were examined using fetomaternal electrocardiography (ECG). The mean FHR (P = 0.004) and the standard deviation of FHR (P = 0.012) significantly decreased during the pregnancy. FHR ± SD values decreased from 115 ± 35 to 79 ± 9 bpm between months 5 and 11. Our data showed that HRV in the foal decreased as the pregnancy progressed, which is in contrast with the findings of earlier equine studies. The standard deviation of normalnormal intervals (SDNN) was higher (70 ± 25 to 166 ± 108 msec) than described previously. The root mean square of successive differences (RMSSD) decreased from 105 ± 69 to 77 ± 37 msec between the 5th and 11th month of gestation. Using telemetric ECG equipment, we could detect equine fetal heartbeat on day 121 for the first time. In addition, the large differences observed in the HR values of four mare-fetus pairs in four consecutive months support the assumption that there might be 'high-HR' and 'low-HR' fetuses in horses. It can be concluded that the analysis of FHR and FHRV is a promising tool for the assessment of fetal well-being but the applicability of these parameters in the clinical setting and in studs requires further investigation.

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Prenatal ages and stages?measures and errors

OʼRahilly

Müller

2000

Teratology

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Background The confusing term “gestational age” is generally either not defined or is used for menstrual “age,” postovulatory age, or postfertilizational age. The designation (post)menstrual weeks and/or days is very useful in obstetrics but, because prenatal age extends from fertilization to birth, menstrual “age” is a misnomer. The term “stage” has a specific morphological meaning in embryology and should not be used either for ages or for lengths. Methods Embryonic age is best assessed, when possible, from the 23 internationally recognized morphological stages. A morphological staging system is not available for the fetal period, and fetal age is assessed mainly from measurements. Results Among these, the unsatisfactory designation crown‐rump length (CRL) should be replaced, in ultrasonic biometry as well as in embryology, by the greatest length (GL), exclusive of the lower limbs. These points are discussed in detail, and justification for the views expressed is provided. Conclusions The continuing confusion concerning prenatal age is shown to be unnecessary once the ambiguous and superfluous term “gestational age” is abandoned. Teratology 61:382–384, 2000. © 2000 Wiley‐Liss, Inc.

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Fetal heart rate variability and complexity in the course of pregnancy

Cited by 139 publications

References 15 publications

Fetal development of complex autonomic control evaluated from multiscale heart rate patterns

Fetal development of complex autonomic control evaluated from multiscale heart rate patterns

Fetal heart rate and fetal heart rate variability in Lipizzaner broodmares

Prenatal ages and stages?measures and errors

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